The Service Line

Kim Brandt, the Centers for Medicare and Medicaid Services (CMS) chief operating officer, told a room of home care operators on Wednesday that any extension of the hospice and home health enrollment freeze has to run a full six months, with no shorter option, and the freeze lapses in two weeks. Speaking at the National Alliance for Care at Home annual meeting in Washington on October 28, Brandt said “we are statutorily required to do six months” and “we do not have the flexibility to say we’re only going to do it for two more months or three more months.” She said CMS has denied 250 home health and 50 hospice applications during the freeze and suspended payments to 899 hospice and home health providers, 812 of them in California, totaling $1.4 billion. She also said she is “not looking to catch the good people” but called some collateral damage “inevitable.” The Alliance’s government affairs chief, Denis Fleming Jr., said the nationwide scope could leave care gaps, particularly in rural areas. As of today we found no extension notice in the Federal Register, and the 60 days’ notice CMS promised in July would have fallen due around September 14; HomeCareRoadmap reports CMS told the Alliance on that date it was “under no obligation” to give it. So the decision is binary, not a trim: extend to mid-May 2027 or let new hospice and agency enrollment reopen on November 13. Plan for both. Confidence: High on the figures and quotes as reported by two trade outlets from the same panel; Medium on the statutory reading, since Brandt’s remarks are not the regulation text; Low on the September 14 “no obligation” message, which we could not confirm independently. Sources: CMS moratorium announcement, CMS hospice and home health moratorium FAQs, CMS COO: Moratorium Has Blocked 250 Home Health Agencies From Medicare Enrollment, Home Health Care News, CMS COO: Hospice, Home Health Moratoria a Successful Approach, Hospice News, Home health and hospice enrollment moratorium decision, HomeCareRoadmap (supplement).

Reimbursement: the 2027 home health payment rule is still not final, two months before it takes effect

We found no final calendar year (CY) 2027 Home Health Prospective Payment System rule as of today, so operators are budgeting against the July proposal. That proposal would raise aggregate Medicare home health payments 2.4 percent ($420 million) while imposing a temporary 3.0 percent cut for the Patient-Driven Groupings Model (PDGM) behavioral effects, with no new permanent adjustment. It would also cut the outlier fixed-dollar loss ratio from 0.37 to 0.29, shorten the deadline for submitting Outcome and Assessment Information Set (OASIS) patient assessments from 4.5 months to 45 days, and seek comment on a home health-specific wage index. For an agency with $10 million in Medicare revenue, the temporary cut alone is roughly $300,000 before the rest of the package nets out. The effective date is January 1, and the final rule has to land first; CMS said it may update the market basket and productivity figures with newer data. Confidence: High on the proposed terms; Low on what changes in the final rule. Sources: CY2027 Home Health PPS proposed rule fact sheet, CMS, CY2027 Home Health PPS proposed rule, Federal Register.

Enforcement: a Los Angeles takedown puts a $138 million hospice scheme, and an 85 percent live-discharge rate, on the record

Federal prosecutors announced charges against 15 defendants on October 22 in Los Angeles in health care fraud cases alleging about $2 billion in losses across several schemes. The hospice portion alleges more than $138 million in fraudulent Medicare billing for patients who were not terminally ill, including a multi-entity scheme across four California hospices that allegedly cycled patients between agencies, used nominee owners, and paid referral kickbacks, with a live-discharge rate above 85 percent, more than four times the national average. Separately, Homestead Hospice reached a $1.93 million False Claims Act settlement in a whistleblower case filed more than a decade ago, per Hospice News. These are allegations, and defendants are presumed innocent. The operator takeaway is the screen, not the case: live-discharge rate and patient cycling are exactly the data points CMS says it uses to pick targets. Confidence: High that charges were announced; Medium on scheme details, which come from trade reporting of the government’s allegations; Medium on the Homestead terms, which rest on a single trade report. Sources: Department of Justice, Central District of California release on the Los Angeles health care fraud takedown, 6 Suspects Arrested in $138M Hospice Fraud Scheme, Hospice News, Homestead Hospice Settles $1.9M Qui Tam Lawsuit, Hospice News.

Who’s Buying: a nonprofit takes 31 hospital-owned agencies, and BrightSpring says its home health census is up 58 percent

Deaconess Associations Incorporated, a Cincinnati-based nonprofit, closed its purchase of 31 home health and hospice agencies from HCA Healthcare, 24 home health locations and seven hospice locations across eight states, most in Texas and Florida, with about 1,000 employees hired through its Central Pyramid subsidiary. Price was not disclosed, and the buyer says it will expand capacity for higher-acuity patients. On the public side, BrightSpring Health Services reported third-quarter results this morning: home health average daily census of 47,256, up 58 percent, including acquired Amedisys and LHC Group branches, Provider Services revenue up 31 percent to $481 million, leverage down to 1.79 times from 2.15 times at June 30, and raised 2026 guidance. Together they show the consolidation lane running through divestitures and tuck-ins while de novo entry is frozen. Confidence: High on the BrightSpring figures from its release; Medium on the Deaconess deal, since terms are undisclosed and the closing date is not stated in the report. Sources: BrightSpring third quarter 2026 results release, via Stock Titan, DAI Closes HCA Hospice, Home Health Transaction, Hospice News.

Clinical Policy: nothing new this week

The scan found no clinical-policy action specific to home health, hospice, or post-acute care in the last seven days beyond the pending payment rule above.

The Operator Metric: VITAS grew hospice census 9.4 percent while accruing $828,000 in Medicare cap, down from $6.1 million

VITAS, the Chemed hospice unit, reported third-quarter average daily census of 24,428, up 9.4 percent, with admissions up 7.2 percent to 18,995 and net patient revenue up 12.2 percent to $457.4 million, about 2.2 points of that from the Medicare rate increase. It accrued $828,000 of Medicare aggregate cap liability against $6.1 million a year earlier; 21 of its 33 Medicare provider numbers have a full-year cushion of 10 percent or more, and five have a billing limitation totaling $6.1 million. The numbers to track are your own census growth against 9.4 percent and your cap cushion by provider number. Whether the freeze is helping incumbents is an open question; the release does not mention it. Confidence: High, figures are from the company’s SEC filing. Source: Chemed third quarter 2026 earnings release, SEC Form 8-K exhibit.